I See You: Cystoscopy

Patient X has been experiencing painful urination for days. He feels this burning sensation every time he urinates. This hasn’t been new to him since he has experienced this for a couple of times already. According to the doctor, he has UTI and has been treated.

However, what patient X does not understand is why his UTI seems to recur from time to time. Does he have any other health problems? Is there something wrong with his urinary system? He barely kept himself to concentrate contemplating on these thoughts as he heads to the hospital to seek medical help.

We are often clued in with signs and symptoms showing on our patients in certain health conditions. From small to big spots of different colors and appearances on the outside, we sometimes get a good guess on what our patient is experiencing.  But how about those we cannot see such as organs located inside our body? How do we know what problem they have or how they look inside? For example, in patient X’s case, how does one know if there really is a problem with the patient’s bladder and/or urethra? Many years ago, this would’ve not been possible. But nowadays, there is a certain procedure that allows visualization of the bladder and urethra.

Cystoscopy must knows

Cystoscopy is the procedure that allows a health professional to view a person’s bladder or urethra using a thin, smooth tube equipped with a bright light and lens called the cystoscope. The urethra is this tube that drains urine from bladder to the outside of body. The cystoscope is slowly inserted to it (urethra) and is slowly advanced into the bladder. Once the end of the cystoscope is in the bladder, sterile water will be passed through it to fill the bladder up and make the whole of the lining visible.

With this procedure, the doctor specifically the urologist will be able to take a look at the areas of the patient’s bladder and urethra that are not shown well on Xrays. It visualizes the bladder lining well that you may be able to spot abnormal growths, ulcers, bulges or stones.

With what you can see during the cystoscopy, you may be able to identify the cause of certain symptoms such as certain bladder conditions like:

  • Urinary stones
  • An enlarged prostate gland
  • Inflammation caused by infection or injury
  • Pouches in the bladder
  • Growths that may or may not be cancerous
  • frequent urinary tract infections
  • blood in your urine
  • loss of bladder control or overactive bladder
  • unusual cells found in urine sample
  • need for a bladder catheter
  • painful urination, chronic pelvic pain, or interstitial cystitis
  • urinary blockage such as stricture, or narrowing of the urinary tract

Yet, cystoscopy is not limited to visualizing the bladder and urethra alone, really tiny surgical instruments may be inserted through the cystoscope to perform removal of samples for biopsy purposes (which will then be taken to the laboratory for analysis), remove small bladder stones and small growths or to collect samples of urine.

Cystoscopy can be used to treat certain conditions such as to:

  • Remove a stone from the bladder. If a stone is trapped in a ureter (the cystoscope may b extended up into a ureter)
  • Obtain a urine sample from each of the ureters.
  • Remove small polyps or tumors from the lining of the bladder.
  • Insert a small tube into a narrowed ureter which helps the flow of urine if there is a narrowing.
  • Perform a special x-ray of the ureters and kidneys; and
  • Remove the prostate gland

Flexible vs. Rigid Cystoscopy

There are two types of cystoscopy, the flexible and the rigid. The main difference among this two is on the flexibility of the cystoscope and the type of anesthesia used.

For Flexible Cystoscopy, the cystoscope easily bends and has a movable ends allowing easy passage along the curves of the urethra. Here, a local anesthesia is used and instilled in the urethra, most commonly, Lidocaine gel. Usually, this type of cystoscopy is used for diagnosis and follow ups regarding bladder tumors.

While local anesthesia is used on both sexes in flexible cystoscopy, in rigid cystoscopy, general anesthesia is used especially in males since the probe brings about discomfort. Here, a solid, straight telescope, which probably has been used for years already, is used with a high intensity light source.

Things to remember when performing cystoscopy:

Before the procedure

  • Patient’s medical and surgical histories, current medications and history of allergies must all be reviewed by the attending physician.
  • Explain to patient the procedure
  • Seek consent.
  • Clear bowels using laxatives and enemas (depending on the reason for cystoscopy)
  • Empty the bladder just before the procedure

During the procedure

  • The procedure must not be started immediately as the anesthetic applied at the tip of the urethra  takes 5-10 minutes before it works
  • Patient may be advised to try passing urine during the insertion (Males) to help relax muscles. (Bladder is empty, no urine will come out)
  • The procedure is usually quick and painless (takes about 5 minutes usually)

After the procedure

  • After the cystoscopy is completed, fluid is drained from the bladder (sterile water used for visualization of the lining)
  • After the examination, the cystoscope is quickly and easily removed.
  • A catheter may be left to continuously drain the bladder (depending on the patient’s condition.
  • Patient may be advised to drink plenty of water (3 liters for 24 hours) to ease mild stinging when urinating and to prevent development of infection and inflammation
  • Bleeding may be present but if it doesn’t slow down in 24 hours, patient experiences difficulty passing urine and signs of infection are present, it calls for immediate medical attention

Cystoscopy Results

A normal cystoscopy result may show that:

  • The urethra, bladder, and ureters are normal.
  • There are no polyps or other abnormal tissues, swelling, bleeding, narrow areas (strictures), or structural abnormalities.

While an abnormal cystoscopy may show:

  • A swelling or narrowing of the urethra because of previous infections or an enlarged prostate gland.
  • Presence of bladder tumors (cancerous or benign), polyps, ulcers, urinary stones, or inflammation of the bladder walls.
  • Presence of abnormalities in the structure of the urinary tract present since birth (congenital)
  • Presence of pelvic organ prolapse  (women).

Some patients might feel uncomfortable and anxious with this procedure. In this case, the nurse must have appropriate knowledge to orient the patient on the procedure itself, to answer the patient’s queries and how it may benefit his health eventually resulting to diminished patient concerns and issues.

 

Sources:

Liane Clores, RN MAN

Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.

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